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Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass

Department of Thoracic and Cardiovascular Surgery and CNRS URA 1431, Association Claude Bernard, Hôpital Henri Mondor, Créteil

Paul Le Besnerais

Department of Thoracic and Cardiovascular Surgery and CNRS URA 1431, Association Claude Bernard, Hôpital Henri Mondor, Créteil

Piet Jansen

Department of Cardiac Surgery, Free University Hospital, Amsterdam

Jean Philippe Mazzucotelli

Department of Thoracic and Cardiovascular Surgery and CNRS URA 1431, Association Claude Bernard, Hôpital Henri Mondor, Créteil

Charles RH Wildevuur

Department of Thoracic and Cardiovascular Surgery and CNRS URA 1431, Association Claude Bernard, Hôpital Henri Mondor, Créteil

Daniel Y Loisance

Department of Thoracic and Cardiovascular Surgery and CNRS URA 1431, Association Claude Bernard, Hôpital Henri Mondor, Créteil

In this prospective randomized trial, we studied whether heparin-coated extracorporeal circuits (ECC), known to reduce complement activation, could improve the clinical outcome of 200 patients undergoing coronary artery surgery. Patients have been divided into two groups (heparin-coated ECC and uncoated ECC groups) which were similar in terms of age, gender, left ventricle function, preoperative aspirin use and consequent intraoperative aprotinin use, number of grafts, duration of aortic cross-clamping and cardiopulmonary bypass.

Univariate analysis showed that heparin coating did not reduce significantly postoperative bleeding (640 ± 311 versus 682 ± 342 ml with uncoated ECC) nor the need for transfusion (19% of patients versus 25% with uncoated ECC). Adverse events, including all mortality and morbidity noticed during the five first postoperative days, occurred in 20 patients of the uncoated ECC group and in eight patients of the heparin-coated ECC group (p = 0.013). The most frequent complications were supraventricular arrhythmias that occurred in 13 patients of the uncoated ECC group and in four patients of the heparin-coated ECC group (p = 0.02). Multivariate analysis by stepwise logistic regression showed that only heparin coating of the ECC was shown as a significant predictive factor of adverse events reduction (p = 0.01; odds ratio = 0.34). These data suggest that heparin coating reduced postoperative complications in patients undergoing coronary artery surgery.

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